Prescription Of Antibiotic Therapy Research Articles

Clinical experience in managing patients with lymphogranuloma venereum.

The article presents two clinical cases of lymphogranuloma venereum with classic manifestations of the disease. In the first case, the stages of lymphogranuloma venereum can be traced: the appearance of a primary affect (ulcer on the penis), the development after a few weeks of regional (inguinal) lymphadenitis and proctitis (anorectal syndrome). On the background of prescribed antibiotic therapy according to the regimen: doxycycline at a dose of 100 mg twice a day for 21 days, the clinical manifestations completely resolved. The second case is interesting in the development of the clinical picture of lymphogranuloma venereum from the second stage of the disease (inguinal syndrome) and the ineffectiveness of treatment with doxycycline, which subsequently required surgical intervention. In addition, in this case, Chlamydia trachomatis DNA was initially detected in a urethral scraping without evidence of urethral inflammation, which is rare for this disease. To treat a patient with “groin syndrome” as a clinical manifestation of lymphogranuloma venereum, a fluoroquinolone antibiotic, levofloxacin, was successfully used according to the regimen: 500 mg twice a day for 28 days.

Antibiotic regimens tailored by clinical pharmacist supported by intensivist enhance rational use of antibiotics

ABSTRACT Background High antibiotics utility rates have been observed in surgical intensive care units (SICU). The present study was performed to evaluate the effect of engaging a clinical pharmacist in SICU on rational use of antibiotic treatment. Methods This retrospective quasi-experimental experiment involved 505 patients, over a period of one year, admitted to emergency department surgical/trauma ICU of a large tertiary care hospital. Before and during pharmacist participation periods of six months, 226 and 153 patients, respectively, are compared. Results Antibiotics consumption pattern changed with a decrease in total antibiotic consumption from 101.42 to 94.1 Defined Daily Dose/100 patients’ days after the clinical pharmacist participation, in addition to, a statistically significant rise (p = 0.001) in percentage of appropriateness of the prescribed antibiotic therapy from 72.1% to 86.3%. Time to control infection (days) was not statistically different (p = 0.825) in both periods. The average ICU days of stay was statistically significant longer (p = 0.046) during pharmacist attendance (4.42 ± 5.61) in comparison with period without pharmacist attendance (3.31 ± 3.66). The difference in ICU mortality rate was not statistically significance (p = 0.217). Cost per stay increased by 65% during pharmacist intervention period. Conclusions Antibiotic management with pharmacist participation as a part of multidisciplinary team with intensivist can promote rate of the appropriateness of the prescribed antibiotic therapy, lower utility of antibiotic consumption, but with a longer ICU stay, no mortality reduction, and higher expenses per stay. Trial Registry ClinicalTrials.gov: NCT04931914.

НОВЫЕ ВОЗМОЖНОСТИ ЛЕЧЕНИЯ И ПРОФИЛАКТИКИ ИНФЕКЦИОННО-ВОСПАЛИТЕЛЬНЫХ ЗАБОЛЕВАНИЙ РЕСПИРАТОРНОГО ТРАКТА

Management of patients with infectious and inflammatory diseases of the upper respiratory tract is one of the most pressing problems of modern medicine, which is associated with the widespread prevalence of this pathology. The main causative agents of acute respiratory infections (ARI) are viruses, but the frequency of unjustified prescription of antibiotic therapy remains high. Despite significant advances in healthcare, questions of the effectiveness and safety of treatment of patients with ARI and the prevention of complications remain largely open to the present day. In this aspect, the possibility of using the original domestic antiviral drug of plant origin Panavir® in respiratory medicine is of particular interest to doctors and patients. The action of Panavir® is aimed at increasing the body’s resistance to the effects of pathogens and the production of interferons - protective proteins produced by the body in response to pathogen invasion. Panavir® is a biologically active polysaccharide obtained from the plant Solanum tuberosum (tuberous nightshade). This substance has a long-term protective effect, prevents the development of inflammation, and accelerates the restoration of the mucous membrane.

Retrospective pharmacoeconomic study of antibiotic therapy in community-acquired pneumonia

Background. The global recommendations for the treatment strategy of community-acquired pneumonia (CAP) include the empirical prescription of antibiotic therapy (ABT) – beta-lactams, fluoroquinolones, macrolides until the results of laboratory tests are obtained to identify the etiological agent responsible for CAP to determine etiotropic therapy. According to the national Russian clinical guidelines, macrolides, fluoroquinolones, cephalosporins and aminopenicillins are recommended for empirical prescription. Meta-analyses found better outcomes in patients treated with a combination of macrolides with beta-lactam compared to beta-lactam alone. At the same time, the clinical benefit of adding macrolides to beta-lactams for the empirical treatment of moderate CAP remains controversial, since the difference in the results of therapy may depend on the age and comorbid conditions of patients.Objective: to analyze the costs of treating CAP with various ABT strategies in order to optimize the cost structure of a medical organization and plan the budget of local healthcare systems.Material and methods. A retrospective epidemiological analysis of extracts from 157 medical records of middle-aged patients in accordance with the World Health Organization classification treated in multidisciplinary medical organizations was carried out. The methods included frequency analysis, cost of illness analysis, cost minimization analysis, and cost-effectiveness analysis. Depth of research was 2 years.Results. Frequency analysis revealed that the initial strategy of ceftriaxone and azithromycin combination (n=74; 47%) prevailed in prescriptions. In terms of the rate of prescriptions, ceftriaxone monotherapy (n=37; 24%) was in the second place. The analysis of the effectiveness of the selected ABT strategies showed that, in general, 113 (72%) of prescriptions were effective. Standard therapy strategies were equivalent in absolute costs and had a similar cost structure.Conclusion. Doctors’ adherence to national clinical guidelines for CAP treatment was found when prescribing the initial empirical ABT, the dominant strategies were identified. Cost of illness analysis demonstrated that the applied strategies were optimal in terms of cost minimization, and cost-effectiveness ratio. The costs structure in therapy with various ABT strategies did not have significant differences. In medical organizations, they adhere to the most rational and cost-effective strategy for CAP treatment and prescribe ABT regimens in each individual case based on risk factors, as well as the results of studies of CAP pathogens sensitivity.

Laser Doppler Flowmeter as a Periodontal Evaluation Method: A Clinical Pilot Study

Background and objectives: Periodontal disease, as an inflammatory pathology, induces hemodynamic changes that can be evaluated by different unbiased methods such as laser Doppler flowmetry. This clinical investigation assesses laser Doppler as a non-invasive procedure to monitor gingival vascularization and its potential relationship with the response to treatment of periodontal disease. Materials & methods: 45 sites of white Spanish patients with active periodontitis undertake a complete periodontal analysis. This included periodontal pathogens identification along with the monitoring of the gingival margin microvascularization using a Doppler laser at the points exhibiting the most periodontal damage. All assessments were performed before and after periodontal combined treatment PCT (scaling, root planing, and antibiotic therapy prescription) (n = 45 sites). Results: Parameters of periodontal disease showed a positive correlation with pathogen levels. Blood flow readings decreased significantly after PCT (p < 0,05), although this parameter was not statistically correlated with periodontal nor microbial assessments in a significant range. Conclusion: Laser Doppler is a complementary method of monitoring periodontal inflammation to traditional techniques of clinical periodontal evaluation. Further studies are necessary to determine its usefulness as a predictive method of periodontal disease evolution.

A new approach to the epidemiological control of infectious diseases in the Russian population

The article describes a development related to the field of public health and molecular biology, in particular, medical diagnostics. We present the Isascreen-8 portable analyzer (Registration Certificate No. RZN 2022/17322, May 24, 2022) and its application for rapid diagnostics of a new coronavirus infection with the use of commercially available sets IsoAmp SARS-CoV-2 (Lytech Co. Ltd., Russia), and also our own development TB-IZATEST (Invention Application No. 2022133809, December 22, 2022) for diagnostics of tuberculosis pathogen. The approach proposed in this article can be used for rapid detection of genetic material (DNA/RNA) of Mycobacterium tuberculosis and SARS-CoV-2 in biological samples using the method of loop isothermal amplification in less than 20 minutes, and also as a universal platform for detection of genetic material of other pathogens in a biological sample. Using the proposed approach, various research tasks for epidemiological monitoring of tuberculosis and new coronavirus infection, qualitative and quantitative analysis of bacterial and viral load in samples, including evaluation of the effectiveness of the prescribed antibiotic therapy regimen, can be solved. The advantage is that this method can be used not only in diagnostic laboratories, but also in field laboratories in the most remote regions of Russia if the mandatory sanitary and epidemiological requirements are observed. With sufficient distribution, the proposed approach could help ensure epidemiological control of the prevalence of these socially significant infections.

Трудности дифференциальной диагностики лимфаденопатии при остром бруцеллезе (клинические случаи)

Brucellosis is a zoonotic disease caused by bacteria of the genus Brucella, characterized by prolonged fever with damage to the musculoskeletal system, nervous, reproductive, cardiovascular and other systems, prone to chronic course. The highest incidence of brucellosis (including among children) over the past 10 years in Russia is registered in Dagestan. One of the manifestations of the reaction of the immune system to the spread of infection in the acute course of brucellosis is generalized lymphadenopathy. Brucella is able to induce incomplete phagocytosis, as a result of which, with a significant accumulation of the pathogen, the lymph nodes become a source of bacteria reproduction, from where they can enter the bloodstream and spread to the cells of the mononuclear phagocyte system, liver, spleen, bone marrow and other organs. With long-term preservation of the pathogen in tissues and organs, brucella causes a specific inflammatory reaction with the formation of granulomas. The acute form of brucellosis is characterized by high fever with a fairly good tolerance. At the end of the first week of the disease, lymphadenopathy appears, an increase in the liver and spleen. All groups of lymph nodes can increase, they can be sensitive to palpation. With the transition of the acute form of brucellosis to the chronic form, the size of the lymph nodes often decrease, sclerosis, become dense on palpation and painless. This condition is called micropolyadenitis. According to the literature, the frequency of lymphadenopathy in the acute course of brucellosis varies greatly, which, apparently, is due to the lack of clear criteria for assessing damage to the lymph nodes, as well as assessing the duration of the disease and the presence of the fact of prescribed antibiotic therapy. The study of lymph nodes in brucellosis is an important part of the general examination of the patient, however, the presence of lymphadenopathy does not always indicate the course of this nosology. In addition, the absence of lymphadenopathy does not rule out brucellosis. The article presents three clinical cases that demonstrate the difficulty in diagnosing brucellosis and the low alertness of doctors in relation to this disease in a non-endemic region.

Empiric versus culture-based antibiotic therapy for UTIs in menopausal women.

To assess the benefits and risks associated with empiric prescription of antibiotic therapy for treatment of a urinary tract infection (UTI). Following IRB approval menopausal women presenting with a symptomatic UTI to a single urology clinic were prospectively assigned to one of the two treatment groups based on day of presentation: culture-based treatment (CB) (Monday, Tuesday, Wednesday) or empiric treatment (ET) (Thursday, Friday) and started on nitrofurantoin (NF) pending culture results. Both groups were contacted at 7 and 14days following treatment. Side effects and answers to a standardized questionnaire (UTISA) were recorded. Success was defined as a total UTISA score < 3. Any NF retreatment, use of another antibiotic therapy, or extension of the original antibiotic course was considered treatment failures. From July 2020 to March 2022, 65 women with 80 UTI events were included in the study, with CB treatment used for 60 UTIs and ET used for 23 UTIs. At 7days after start of treatment, questionnaire failure rate was 44% (20/45) for the CB group and 16% (3/19) for the ET group (P = 0.076). At 14days following start of treatment, questionnaire failure rate was 31% (13/42) for the CB group and 17% (3/18) for the ET group (P = 0.3). In the ET group, 11% of cultures were found to be resistant to NF. Outcomes for the empiric treatment of uncomplicated UTI with NF at both 7 and 14days are not significantly different than outcomes with culture-based treatment.

1386. Prescribing Patterns of Skin and Soft Tissue Infections in Patients Discharged from the Emergency Department

Abstract Background Treatment of skin and soft tissue infections (SSTIs) are a growing reason for Emergency Department (ED) visits. Inadequate treatment of SSTIs has been reported in up to 25% of patients treated in ED. The purpose of this project was to describe prescribing patterns for SSTIs from the ED. Methods Single center retrospective cohort study of SSTI patients discharged from ED between July 1- December 31, 2020. The primary outcome was to describe the proportion of patients receiving guideline directed therapy (GDT) for SSTIs. Secondary outcomes include describing the proportion of patients readmitted within 30 days, the reason for readmission, and to compare 30-day readmission rates in patients who received GDT versus non-GDT. Results Of 876 patients screened, 576 were excluded primarily for being admitted to the hospital. Of the 300 included patients, 117 (39%) received GDT and 183 (61%) received non-GDT. Fifty-six of 300 patients were readmitted within 30 days, of which 21 (17.9%) had received GDT and 35(19.1%) had received non-GDT (p=0.8). Readmissions related to persistence or progression of SSTI were not significantly different between GDT and non-GDT, 9 patients and 11 patients respectively (p=0.57). The remaining 36 patients (64.3%) were readmitted for reasons unrelated to SSTI. Conclusion The majority of prescribed antibiotic therapy for SSTI did not conform to GDT. However, 30-day readmission rates were not significantly different between the groups. Further research on GDT and ED treated SSTI is needed. Disclosures All Authors: No reported disclosures.

2244. Prescribing Patterns of Urinary Tract Infections in Patients Discharged from the Emergency Department

Abstract Background Urinary tract infections (UTIs) are one of the most common infections in the emergency department (ED). The risk of treatment failure and readmissions to the ED may be increased with inappropriate antibiotic regimens. The purpose of this project is to determine the proportion of patients receiving guideline-based therapy (GBT) for UTI discharged from the ED. Methods Single-center, retrospective cohort study of adult patients diagnosed with an UTI or pyelonephritis from July 1-December 31, 2020. The primary outcome was to describe the proportion of patients discharged from the ED who received GBT for UTI. Secondary outcomes were to define the proportion of patients readmitted within 30 days, describe the reason for readmission, and compare 30-day readmission rates in patients who received GBT versus non-GBT. Results Of 370 patients screened, 68 were excluded primarily for inpatient admission. Of the 302 patients included, 172 (57%) received GBT and 130 (43%) received non-GBT with no significant difference in Charlson Comorbidity Index (p= 0.48) between groups. Fifty two of 302 patients (17.2%) were readmitted within 30 days; 31 (60%) from GBT and 21 (40%) from non-GBT (p=0.632). Of the 52 readmissions, 14 (26.9%) were related to the UTI and returned for either persistent symptoms (11 patients) or development of sepsis (3 patients). Readmissions related to persistence of UTI and development of sepsis were not significantly different between GBT and non-GBT, 9 patients and 5 patients respectively (p=0.92). Conclusion The majority of prescribed antibiotic therapy did conform to GBT for UTI. However, 30-day readmission rates were not significantly different between groups. Disclosures All Authors: No reported disclosures.

Features of treatment of C. difficile associated diarrhea in patients with new coronavirus infection

The pandemic of a new coronavirus infection in recent years has led to more frequent and aggressive prescription of antibiotic therapy, which could not but affect the intestinal microbiota. In addition, the direct effect of coronavirus on enterocytes leads to the development of subclinical inflammation in the intestinal wall, contributing to the disruption of the qualitative and quantitative composition of the normal intestinal microflora. Against this background, the number of patients with antibiotic-associated diarrhea, including diarrhea caused by C. difficile, including severe ones. Moreover, the number of clostridial diarrhea resistant to classical vancomycin therapy has increased, which dictates the need to find new ways to treat patients and methods for further prevention of such conditions.

Factors That Influence the Prescription of Antibiotic Therapy at the End-of-Life: Construction and Validation of a Scale.

End-of-life care is frequently discussed in clinical practice. Non-beneficial treatments and the need for decision-making regarding therapeutic institutions are increasingly addressed. There are no guidelines regarding prescribing or de-prescribing antibiotic therapy at the end of life, which depends on clinical decisions. In this study, we developed a scale to assess the factors influencing clinicians' decisions when prescribing antimicrobial agents. This is a quantitative, exploratory, and descriptive study. After the literature review, the scale was constructed with an analysis of internal consistency and temporal stability. It was applied online together with a sociodemographic and clinical questionnaire. Statistical analysis of the scale, its construction, and final validation were performed. A total of 196 physicians participated in this study (76.5% female, 78.6% aged <40 years), 60.2% specialists, and 35.7% without palliative care training. Almost all of the participants (89.9%) reported having end-of-life care concerns with a high frequency. In this study, a scale was developed to assess factors associated with the prescription of antibiotic therapy in end-of-life patients. This scale revealed the presence of 3 factors: infection, patient/illness, and symptoms. Together, the three factors explain 57.4% of the clinician's decisions. The factors associated with symptoms were the most predominant in decision-making compared to those associated with infection. Among the multiple factors that may influence the institution of antibiotic therapy at the end of life, symptomatic control is the most important factor.

24/7 workflow for bloodstream infection diagnostics in microbiology laboratories: the first step to improve clinical management.

We aimed to evaluate the impact of an uninterrupted workflow regarding blood cultures on turnaround time and antibiotic prescription. Monomicrobial episodes of bacteremia were retrospectively evaluated before and after a continuous 24/7 workflow was implemented in our clinical microbiology laboratory (pre- and post-intervention periods; PREIP and POSTIP). Primary outcome was the time from specimen collection to the first change in antibiotic therapy. Secondary outcomes included the time from specimen collection to effective antibiotic therapy and to antibiotic susceptibility testing results (or turnaround time), as well as hospital length of stay and all-cause mortality at 30days. A total of 548 episodes of bacteremia were included in the final analysis. There was no difference in PREIP and POSTIP regarding patient characteristics and causative bacteria. In POSTIP, the mean time to the first change in antibiotic therapy was reduced by 10.4h (p<0.001). The time to effective antibiotic therapy and theturnaround time were respectively reduced by 4.8h (p<0.001) and 5.1h (p=0.006) in POSTIP. There was no difference in mean hospital length of stay or mortality between the two groups. Around the clock processing of blood cultures allows for a reduction in turnaround time, which in turn reduces the delay until effective antibiotic therapy prescription.

Prospects for the Use of NGAL and KIM-1 for the Diagnosis of Acute Kidney Injury in Patients Receiving Antibacterial Therapy

The developers of Clinical Practice Guidelines for Acute Kidney Injury titled The Initiative to Improve Global Kidney Disease Outcomes (KDIGO) point at the need of new biomarkers for diagnosis acute kidney injury (AKI).The objective: to study and evaluate the diagnostic significance of the levels of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) in patients with AKI in the early postoperative period when antibiotic therapy is used.Subjects and Methods. AKI frequency was assessed in 276 patients during the early postoperative period after the antibacterial drugs had been prescribed. Serum levels of KIM-1 and NGAL, glomerular filtration rate (GFR), creatinine, protein in urine were tested before the start of antibiotic therapy, in 24–48 hours, and in patients with AKI – additionally in 72–96 hours. The normal initial renal excretory function was registered only in 36 patients (13.04%). The majority of patients (242 patients, 86.96%) were diagnosed with chronic kidney disease of various stages.Results. NGAL and KIM-1 levels were higher in the group of patients with AKI before start of antibiotic therapy versus the group of patients with preserved renal function. However, a statistically significant increase in the level of KIM-1 and NGAL was found only in the group of patients with stages 3A and 3B of CKD versus the groups of patients with stages 1 and 2 of CKD. The second important observation is that a comorbid pathology in patients led to a high AKI incidence when antibiotic therapy was used – 35.86% (30–42%; 95%CI).Conclusion. The relationship of NGAL and KIM-1 levels with glomerular filtration rate (GFR) and KIM-1 level with the presence of proteinuria as indicators of impaired renal filtration function suggests that NGAL and KIM-1 levels reflect the state of renal filtration function. Based on this observation, it should be accepted that NGAL and KIM-1 levels can be used as markers for the diagnosis of AKI in patients receiving antibiotic therapy. The prescription of antibiotic therapy in the postoperative period in patients with surgical pathology and renal dysfunction leads to a high AKI incidence. Elevated KIM-1 and NGAL levels in AKI during the antibiotic therapy suggests their involvement in the reparation process.

Whole genome sequencing of &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; strains isolated from hospital patients in the northern territories of the Tyumen region

Introduction. is to The analysis of the genetic relatedness of isolates aiming to find the source of infection is an important task of nosocomial infection control. The most common causative agent of healthcare-associated infections is Acinetobacter baumannii.Objective. To evaluate the results of whole genome sequencing of A. baumannii bacteria isolated from clinical samples of patients undergoing inpatient treatment in the northern territories of the Tyumen region.Materials and methods. Nine isolates of A. baumannii from the clinical material of patients were studied. Bacterial cultures were identified by mass spectrometry. Whole genome sequencing, multilocus sequence typing and search for markers of antibiotic resistance were performed.Results. The studied strains belonged to sequence types ST2 and ST187, and to the international clonal complex CC2. All A. baumannii isolates were found to have beta-lactamase genes, as well as genes for resistance to aminoglycosides, to the MLS group of antibiotics, and to tetracyclines. The presence of a cluster of genes associated with virulence was detected: those responsible for the synthesis of acinetobactin and iron binding, surface antigen 1 and porin.Conclusion. Based on data of a single nucleotide polymorphism (SNP) analysis, A. baumannii isolates from the clinical material of patients of healthcare institution #1 belong mainly to one bacterial strain. Isolates of A. baumannii from the clinical material of patients of healthcare institution #2 are closely related. The ability to distinguish clinical isolates of A. baumannii at the level of several SNPs per genome will improve the identification of the source of infection, and whole genome sequencing data can contribute to the rational prescription of antibiotic therapy and the correction of disinfection and antiseptic measures.

Assessment of C reactive proteins levels in patients with dental implant failure

Background: The present study was undertaken for assessing C reactive proteins levels in dental implant failure patients. Materials &amp; methods: A total of 100 patients who were schedule to undergo prosthetic rehabilitation of missing mandibular molars were enrolled. Baseline hematological and biochemical variables were evaluated. All the dental implant procedures were carried out under adequate septic conditions. All the patients were put of prescribed antibiotic therapy postoperatively. All the patients were evaluated radiographically after three months for prognosis. C Reactive proteins levels were evaluated in all the patients and were compared between patients on the basis of prognosis. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: Mean C Reactive proteins levels among patients with Dental implant failure and among patients with successful dental implants was 0.89 mg/dL and 0.21 mg/dL respectively. Significant results were obtained while comparing the C Reactive proteins levels among patients with Dental implant failure and among patients with successful dental implants.Conclusion: C Reactive proteins could be used as a successful marker for monitoring the success dental implant therapy.

Evaluation of management of patients under clean intermittent catheterization by general practitioners

Clean Intermittent Catheterization (CIC) is the method of choice for bladder emptying in patients having bladder emptying disorders, acquired or pharmacologically induced, whether it is neurologically related or not. The aim of this study is to assess the theoretical and practical knowledge of general practitioners (GP) on CIC. Observational prospective study (anonymous online questionnaire) was conducted with 224 GP between March and April 2020. Each physician had to complete a questionnaire about the definition of CIC, its indications and usage, the indications of urine culture, antibiotic therapy, and the complications of this method of drainage. Only 18.3% of GP that took part in the study gave an exact definition of CIC. As to the importance of it, 67.9% responded that it protects the upper urinary tract and 37.1% that it prevents urinary tract infections (UTI). Fifty-two per cent of physicians were unaware of the regular frequency at which it should carry out a day. Fifty eight percent prescribed sterile gloves and 57.1% an antiseptic. UTI was considered as the main complication of CIC by 87.1% of physicians and 35.7% requested a systematic urine culture for patients under CIC. For patients with an asymptomatic bacteriuria, 65.6% of GP prescribed antibiotic therapy. GP need to improve their knowledge of SIP, its framework, indications, modalities, and the way to deal with colonization or urinary tract infection. This will improve the management of impacted patients.

Oral antibiotic prescription patterns for dental conditions at two public sector hospitals in Pietermaritzburg, KwaZulu-Natal

Antibiotic resistance is a growing public health concern. Yet, there is a paucity of published data in KwaZulu-Natal on antibiotic prescription trends and patterns related to dental use. The objectives of this study were to identify the range of dental conditions for which oral antibiotics are prescribed at two public health settings (Institution A and B) in the Pietermaritzburg Complex, KwaZulu-Natal and to explore practitioner understanding of the indications for antibiotic prescription for dental conditions. The study used a two-phased approach and collected a combination of qualitative and quantitative data. Phase 1 comprised a retrospective clinical chart review (n=720), while phase 2 comprised a focus-group discussion with purposively selected health care practitioners at each institution. The results of the retrospective clinical chart review indicated that dental abscesses were the most common dental infections requiring oral antibiotic therapy (n= 479; 66%), followed by acute alveolar osteitis (dry socket) (n=110; 15%), dental impactions (n=78; 11%) and dental extractions (n=62; 9%). At Institution A, antibiotic therapy was prescribed for conditions such as trismus (n=13; 6%), soft palate swelling of unspecified origin (n=9; 4%), fibrous epulis (n=6; 3%) and acute herpes simplex (n=2; 1%). Interestingly, antibiotics were not prescribed at Institution B for the same dental conditions. Antibiotic therapy was also prescribed for eruption pain (n=4; 1%) and for cases when patients did not bring their inhaler for asthma treatment (pump) (n=3; 1%). The findings from the focus-group discussions suggested that there is a need to improve practitioner understanding of the indications for antibiotic prescriptions for dental conditions. This study showed some differences in antibiotic therapy prescription patterns at the two public health institutions, especially for dental conditions that did not require such management. This suggests a need for consensus building among health professionals and the provision of more dedicated guidance for antibiotic prescription in the management of dental conditions.

Diagnosis and management of pharyngitis in children: a survey study in Ukraine.

The purpose of our study was to evaluate the knowledge of pediatricians in diagnosis and management of sore throat in children and to identify further ways to raise their awareness. We conducted a survey among pediatricians on evaluation of diagnosis and management of pharyngitis in children. The study involved pediatricians of Ternopil region, Ukraine. Overall, 112 pediatricians participated in the study. Among the participants 79 (70.5%) were primary care physicians and 33 (29.5%) worked in the secondary and tertiary care hospitals. Overall, 70.5% of pediatricians prescribed a throat swab for patients with pharyngitis in selected cases. However, they rarely (20 %) used Centor or McIsaak criteria to choose management strategy of sore throat. Amoxicillin as a first-line antibiotic for streptococcal pharyngitis was chosen by 66.1% of respondents and primary care pediatricians prescribed it more often than pediatricians in hospitals (p<0.001), but antibiotic therapy was prescribed for 10 days only by 52.7% of respondents. Less than half of the correct answers were to the questions related to prescription of antibacterial therapy in healthy children, in which GAS is detected in throat swab (39.3%) and in cases of positive antistreptolysin O (ASL-O - 25.9%). The study showed a wide range of knowledge of pediatricians about the diagnosis and management of GAS pharyngitis - from satisfactory responses concerning prescription of antibiotic therapy to low level of knowledge about the diagnosis and determination of strategies in healthy carriers. These data emphasize the need to improve knowledge about the strategies of GAS pharyngitis control.

DIAGNOSTICS, DIFFERENTIAL DIAGNOSTICS AND TREATMENT OF PANDAS SYNDROME: DESCRIPTION OF THE CASE

This article gives a case of PANDAS syndrome in an 11-year-old boy. The course and clinic of the disease in the form of prolonged bouts of sneezing made it difficult to diagnose this syndrome. Biochemical blood tests, 24-hour video electroencephalographic monitoring (EEG monitoring) and magnetic resonance imaging of the brain (MRI) made it possible to determine the condition. Prescription of antibiotic therapy and intravenous administration of immunoglobulin led to remission of the disease. It is necessary to conduct further research to determine the effectiveness of the above drugs introduced above for this syndrome.